Recovery of Function Following a Hip Fracture in Geriatric Ambulatory Persons Living in Nursing Homes:: Prospective Cohort Study

• Autores: Lauren A. Beaupre, C. Allyson Jones, William C. Johnston, Donna M. Wilson, Sumit R. Majumdar
• Localización: Journal of the American Geriatrics Society, ISSN 0002-8614, Vol. 60, Nº. 7, 2012, págs. 1268-1273
• Idioma: inglés
• Texto completo no disponible (Saber más ...)
• Resumen

  • Objectives: To measure 1-year post-hip fracture functional recovery, health-related quality of life (HRQL), and mortality in nursing home residents.

    Design: Prospective longitudinal cohort study.

    Setting and Participants: Ambulatory nursing home residents with or without impaired cognition consecutively admitted with hip fracture to three Canadian tertiary-care hospitals from March 2008 through November 2009.

    Measurements: Participants or proxy respondents completed the Functional Independence Measure Motor score (FIMmotor) and EuroQol5D index score (EQ-5Dindex) in the hospital (prefracture status) and 3, 6, and 12 months after fracture. Complications over the first postfracture year were also ascertained; the primary outcome was functional recovery (change in FIMmotor score).

    Results: Of 92 eligible participants, 60 (64%) were enrolled. The mean age was 86.9 ± 8.1, 42 (70%) were female, and 45 (75%) had three or more comorbidities. Forty-three (72%) walked independently with or without aids before fracture. By 12 months, 27 (45%) participants had died, and 10 (17%) had withdrawn. Of the remaining 23 participants, functional status according to FIMmotor score dropped substantially and significantly after the fracture (3 months, 34.0 ± 19.7; 6 months, 33.2 ± 19.7; 12 months, 32.0 ± 20.0; P < .001 from a baseline FIMmotor score of 50.1 ± 16.1). By 12 months after the fracture, only eight (35%) were walking independently, and 11 (48%) were no longer ambulatory. HRQL according to the EQ-5Dindex also decreased significantly (P = .003), from 0.62 ± 0.20 before fracture to 0.42 ± 0.30 by 12 months after fracture.

    Conclusion: Hip fracture for nursing home residents was associated with substantial loss of functional independence, ambulation, and HRQL. Little recovery was evident after the first 3 months; there was almost 50% mortality within 12 months.